Association between Obesity and Atrial Function in Patients with Non-Valvular Atrial Fibrillation: An Echocardiographic Study.

Background: Obesity is a public health problem which prevalence has increased worldwide and is associated with different degrees of hemodynamic alterations and structural cardiac changes. The aim of the study is to investigate the impact of body mass index (BMI) on left atrial function using standard and advanced echocardiography in a population of patients with non-valvular atrial fibrillation (AF). Methods: 395 adult patients suffering from non-valvular AF, divided into three tertiles based on BMI value, carry out a cardiological examination with standard and advanced echocardiography. Results: Peak atrial longitudinal strain (PALS), a measure of left atrial function, is lower in the tertile with highest BMI (14.3 ± 8.2%) compared to both the first (19 ± 11.5%) and the second tertile (17.7 ± 10.6%) in a statistically significant manner (p < 0.002). Furthermore, BMI is significantly associated independent with the PALS by multilinear regression analysis, even after correction of the data for CHA2DS2-VASc score, left ventricular mass index, left ventricular ejection fraction, E/E' ratio and systolic pulmonary arterial pressure (coefficient standardized ß = -0.127, p < 0.02; Cumulative R2 = 0.41, SEE = 0.8%, p < 0.0001). Conclusions: BMI could be considered an additional factor in assessing cardiovascular risk in patients with non-valvular atrial fibrillation, in addition to the well-known CHA2DS2-VASc score.

Preliminary Results of a Double-Blind Randomized Controlled Trial Evaluating the Cardiometabolic Effects of Levothyroxine and Liothyronine Compared to Levothyroxine with Placebo in Athyreotic Low-Risk Thyroid Cancer Patients.

Background: Evidence is needed on the risks and benefits of combination therapy with levothyroxine (LT4)+liothyronine (LT3) for the treatment of hypothyroidism. Objective and Methods: We performed a randomized, double-blind placebo-controlled study to assess the effects of LT4+LT3 therapy versus LT4+placebo in a homogeneous group of athyreotic patients, without cardiovascular risk factors during long-term replacement monotherapy with LT4. The primary objective of the study was to assess the effects of combination LT4+LT3 therapy on heart rate, cardiac rhythm, and sensitive cardiovascular parameters of cardiac morphology and function by means of electrocardiography and Doppler echocardiography. The secondary objective of the study was to evaluate patient compliance, tolerability, and potential adverse events. Results: Thirty-eight patients with postsurgical hypothyroidism satisfying the inclusion criteria were selected from a group of 300 patients with low-risk thyroid cancer followed for a routine follow-up; they were randomized to receive LT4+LT3 or LT4+placebo. Twenty-four patients were evaluated after 1 year of treatment. All clinical and laboratory parameters were compared with the results obtained from 50 healthy euthyroid volunteers without comorbidities, matched for gender, age, physical activity, and lifestyle. Participants and clinicians remained blinded to the treatment allocation. After 1 year of combination therapy, a significant improvement in the diastolic function, evidenced by a significant reduction in the E/e' ratio (p = 0.046) and its positive trend over time, was observed in the LT4+LT3 group versus the LT4+placebo group. In addition, the univariate analyses showed a significant relationship between free triiodothyronine (fT3) levels (in pg/mL) with Δ of variation of the E/e' ratio in the LT4+LT3 group (standardized ß coefficient = 0.603 [confidence interval: 0.001-1.248], p = 0.050) after combination therapy. No adverse events including tachycardia, arrhythmias, atrial fibrillation, or other important events occurred between the first administration and the end of the study. Conclusions: In this preliminary report, combination treatment with LT4+LT3 induced favorable changes in cardiovascular parameters of diastolic function without any adverse cardiovascular events. Trial Registration: EUDRACT number: 2017-001261-25.

Right Ventricular Myocardial Involvement in Anderson-Fabry Disease at Diagnosis: Evaluation with Three-Dimensional Strain Imaging.

Background: Right ventricular (RV) involvement in Anderson-Fabry disease (AFD) is well known in the advanced stages of the disease RV hypertrophies, but little is known about the early involvement. The aim of our study was to assess RV function in AFD patients at diagnosis. Methods: A total of 23 AFD patients and 15 controls comparable for age and sex were recruited. A complete 2D standard echo with 3D volumetric and strain analysis of RV was performed. Results: Two patient populations, comparable for clinical baseline characteristics were considered. RV free wall thickness was significantly increased in the AFD group. No significant differences in standard RV indices (TAPSE, transverse diameter, tissue Doppler velocities of the lateral tricuspid annulus) were found. A 3D volumetric analysis showed reduced RV ejection fraction and lower values of longitudinal septal, free wall and global longitudinal strain (GLS) in AFD patients. RV free wall thickness significantly correlated with both free wall RV LS and RV GLS. In multiple linear regression analysis, RV free wall thickness was independently associated with RV GLS even after correction for age and heart rate. Conclusions: In AFD patients, 3D echocardiography allows for the identification of early subclinical functional impairment of RV. RV dysfunction is independently associated with RV hypertrophy.

Towards Universally Designed Communication: Opportunities and Challenges in the Use of Automatic Speech Recognition Systems to Support Access, Understanding and Use of Information in Communicative Settings.

Unlike physical barriers, communication barriers do not have an easy solution: people speak or sign in different languages and may have wide-ranging proficiency levels in the languages they understand and produce. Universal Design (UD) principles in the domain of language and communication have guided the production of multimodal (audio, visual, written) information. For example, UD guidelines encourage websites to provide information in alternative formats (for example, a video with captions; a sign language version). The same UD for Learning principles apply in the classroom, and instructors are encouraged to prepare content to be presented multimodally, making use of increasingly available technology. In this chapter, I will address some of the opportunities and challenges offered by automatic speech recognition (ASR) systems. These systems have many strengths, and the most evident is the time they employ to convert speech sounds into a written form, faster than the time human transcribers need to perform the same process. These systems also present weaknesses, for example, a higher rate of errors when compared to human-generated transcriptions. It is essential to weigh the strengths and weaknesses of technology when choosing which device(s) to use in a universally designed environment to enhance access to information and communication. It is equally imperative to understand which tools are most appropriate for diverse populations. Therefore, researchers should continue investigating how people process information in a multimodal format, and how technology can be improved based on this knowledge and users' needs and feedback.

Towards a More Inclusive Learning Environment: The Importance of Providing Captions That Are Suited to Learners' Language Proficiency in the UDL Classroom.

Captions have been found to benefit diverse learners, supporting comprehension, memory for content, vocabulary acquisition, and literacy. Captions may, thus, be one feature of universally designed learning (UDL) environments [1, 4]. The primary aim of this study was to examine whether captions are always useful, or whether their utility depends on individual differences, specifically proficiency in the language of the audio. To study this, we presented non-native speakers of English with an audio-visual recording of an unscripted seminar-style lesson in English retrieved from a University website. We assessed English language proficiency with an objective test. To test comprehension, we administered a ten-item comprehension test on the content of the lecture. Our secondary aim was to compare the effects of different types of captions on viewer comprehension. We, therefore, created three viewing conditions: video with no captions (NC), video with premade captions (downloaded from the university website) (UC) and video with automatically generated captions (AC). Our results showed an overall strong effect of proficiency on lecture comprehension, as expected. Interestingly, we also found that whether captions helped or not depended on proficiency and caption type. The captions provided by the University website benefited our learners only if their English language proficiency was high enough. When their proficiency was lower, however, the captions provided by the university were detrimental and performance was worse than having no captions. For the lower proficiency levels, automatic captions (AC) provided the best advantage. We attribute this finding to pre-existing characteristics of the captions provided by the university website. Taken together, these findings caution institutions with a commitment to UDL against thinking that one type of caption suits all. The study highlights the need for testing captioning systems with diverse learners, under different conditions, to better understand what factors are beneficial for whom and when.